毛果芸香碱滴眼液在急性闭角型青光眼发作中应用的临床思考

The clinical thinking of how to use pilocarpine nitrate eye drops on prime acute angle closure glaucoma attack

目的通过对毛果芸香碱滴眼液在急性闭角型青光眼发作眼的治疗情况和效果的回顾分析,探讨该药在治疗过程中合理的使用方法。方法回顾2013年1月1日至2013年12月31日在院诊断为急性闭角型青光眼并接受治疗的患者共64人,77只发作眼。收集患者入院时发作眼眼轴、中央前房深度(IOL Master测量)、眼压、用药情况及用药效果等资料,观察并发症的发生情况,进行分组比较。结果所有77只发作眼的眼轴长度平均(22.12±0.9)mm,中央前房深度平均(2.23±0.17)mm。其中,有50只眼进行了毛果芸香碱滴眼液频点,用药前眼压平均(52.64±10.35)mm Hg,另外27只眼没有进行毛果芸香碱滴眼液频点,用药前眼压平均(47.37±14.66)mm Hg,经t检验,用药前眼压差异无统计学意义(t=1.658,P=0.105>0.05)。50只进行毛果芸香碱滴眼液频点的发作眼中有26只眼眼压得到了有效控制,有效率为52%;没有进行毛果芸香碱滴眼液频点的27只眼中有17只眼眼压得到了有效控制,有效率为62.96%,经χ2检验,两组有效率差异无统计学意义(χ2=0.855,P=0.355>0.05)。在所有发作眼中有3只眼经过毛果芸香碱滴眼液频点治疗后出现与用药相关的并发症。这3只眼眼轴均小于22mm。结论在原发性急性闭角型青光眼发作期的治疗中,局部频点毛果芸香碱滴眼液与每日四次局部用药相比较,不但不能提高眼压控制的有效率,而且增加患者发生药物相关并发症的风险,尤其对于短眼轴患者,不宜作为常规治疗方法。

Objective To determine the rational treatment method of pilocarpine nitrate eye drops on prime acute angle closure glaucoma（ PAACG） attack by retrospective analysis of its curative effect. Methods This study was a retrospective review of the records of 64 adult patients（ 77 eyes） with PAACG. All the eyes had been treated with instillation of 0. 5% pilocarpine nitrate eye drops,and the treatment effect of 50 eyes of 44 patients with frequent application（ group 1） were compared with 27 eyes from 20 patients with four times daily（ group 2）. Ocular axis,intraocular pressure（ IOP）,the anterior chamber depth（ ACD）,and complications of the two groups were compared. Results For all the 77 eyes,the mean ocular axis was（ 22. 12 ± 0. 9） mm,mean ACD was（ 2. 23 ± 0. 17） mm. Before treatment,there were no significant differences in IOP between the 2groups（ P〉0. 05）. After treatment,26 in 50 eyes with IOP were controlled effectively in group 1,the effective rate was 52%. And the rate of group 2 was 62. 96%（ 17 of 27 eyes）. There were no significant differences in the effective rate between the 2 groups（ P〉0. 05）. The complications relevant to the drug occurred in 3 eyes after instillation of 0. 5% pilocarpine nitrate eye drops by frequent application,and the ocular axis of these 3 eyes were shorter than 22 mm. Conclusions During the treatment of primary acute angle closure glaucoma attack,the frequent application of 0. 5% pilocarpine nitrate eye drops cannot improve the efficiency of intraocular pressure control,on the contrast increase the risk of complications. Especially for short ocular axis patients,frequent application should not used as a routine treatment method.